OB RMT

Contents

Abortion/Threatened Abortion

If a POC HGB and vital signs are stable this patient may go to the ER in Bethel on the next available flight. She should be warned that she may in be in Bethel for at least 2-3 days as part of the evaluation. There is also a risk she may bleed to death if she remains in the village.

If contractions do not stop and it is before the BIB, activate a medevac.

If it is after the BIB and there is a compelling reason such as possible breech or transverse presentation or hypertension, consult HROB and consider a medevac.

If contractions stop, can monitor in village until they can come in commercial.

Do not fly someone commercial who could deliver en route regardless of gestational age.

You really cannot tell who is or is not in labor over the phone— do not hesitate to consult HROB for these patients.

Medevac

Do not medevac an uncomplicated pregnancy in labor who missed her BIB. The CHA will need to deliver in the clinic with your support over the phone. Have them come in commercial ASAP after delivery unless a problem arises.

Phone * 96 to activate medevac—let them know 2 physicians will fly; get ED to fax face sheet and PTO, which you have filled out.

Do not send the resident as the FP. This is a potentially difficult situation.

Contact peds on call to prepare to come if preterm infant expected.

Notify back-up that a physician with delivery privileges needs to go on medevac—back-up will either fly or come in to cover the hospital depending on time of day or other considerations. During the day it is your partner on wards.

Back-up physician needs to know what you have done and what you are thinking since they will be managing the RMT with the village while you are in flight. Have them assume your role in Tiger Text. Please make sure the backup physician also assumes the peds wards on call role while the pediatrician is out. If a delivery is imminent, make sure the CHAs know to get the clinic or delivery room VERY warm (sweaty warm), get out a baby or premie bag and mask, plus clean towels and blankets on a surface with a lamp or other heating source, baby hat and saran wrap if needed..

Notify ED, L&D, Northwing and the operator, so everyone knows who will be covering FP and Peds roles for the duration of the medevac.

Gather needed supplies in L&D. They have a med pack and an equipment pack. Check to be sure there is betamethasone, toradol, antibiotics and nefedipine.

Arrange transportation to hangar—Take a cab or your car to LifeMed Hanger at 3600 Tower Road (next to ACE Hanger). If you take your car you may have to get the car later. You may need to remain with the mom or baby in the ambulance to the hospital. Ensure the entire team is on the same page as to who is going on the medevac and how they are getting to the hanger. Dispatch can contact crew if issues arise while preparing to go or if you anticipate delays of more than 20 minutes to get to hangar.

Don’t get in the flight crew’s way—ask where they need you to sit and what you can do to help.

In the village

Ask what you can do to help get gear to clinic

Medevac crew will get VS while you assemble supplies

Make sure there is clear communication with everyone as to plans

Clear the room of extraneous people

Set up to do sterile spec, obtain FFN and cultures

You might not have a lithotomy table-speculum can be inserted stem up or patient can be placed on some kind of lift. The health aide can hold an otoscope or flashlight if no gooseneck available for illumination.

Check cervix after obtaining samples if no concern of previa

Radiate calm and be decisive

Make decision on disposition

Imminent delivery—stay and deliver in clinic—Pediatrician will prepare for and manage the infant(s)

Cervix closed—go to Bethel

Cervical change but delivery not imminent—talk to high risk OB and ANMC about Bethel versus ramp transfer to ANMC.

Cervix open but undeliverable lie—consult as to Bethel vs. ANMC for management